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Drug efficacy: - drug’s effect on a disease under ideal circumstances i.e: -controlled clinical trial -defined regiment -compliance is assured Drug effectiveness: - overall outcome prescribing a drug has in actual clinical practice where the efficacy of a drug is modulated by more extraneous factors than occur in a clinical trial. Ideally,pharmacoeconomic should report on the effectiveness of a drug,not efficacy

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Pharmacoeconomic studies: Cost minimization; - This study or analysis evaluates only the monetary costs of the therapy. - Appropriate when the outcome of the drug and another treatment are the same. -In such a case the decision to use one drug or another is related only to cost Cost-benefit analysis; - Outcomes are expressed in monetary terms. -the cost of a drug regiment or a health program is compared with nonmedical costs such as a cost to protect the environment,education or defence.

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Cost-effectiveness analysis: -Cost are associates with outcomes as measured in physical units such as mmHg reduction in blood pressure,stroke prevented,hospital days prevented or lives saved Cost- utility analysis; -Variation of cost-effectiveness analysis -Outcomes are transformed to some measure of utility such as Quality Adjusted Life Years (QALY) -----  quantity (Mortality) and quality (morbidity)

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Pharmaco-economic Adding drugs to the formulary involves careful consideration of: –Efficacy –Safety –Quality –Cost Cost factors are becoming more important Science of pharmacoeconomics is emerging –Cost (total resources consumed in producing a good or service) –Price (the amount of money required to purchase an item)

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Objectives Objectives of pharmacoeconomics and outcomes research must originate within three dimensions when considering results and value of healthcare –Acceptable clinical outcomes –Acceptable humanistic outcomes –Acceptable economic outcomes

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Gysling E. Me too's and generics. Schweiz Rundsch Med Prax. 88(16):709-12,1999. Generics are pharmaceutical products –containing the same active substance as an original branded medication. –used in order to reduce the cost of pharmacotherapy. –have to be bioequivalent to the original drug-their mean "area under the curve" (AUC) should not deviate from the AUC of the original by more than 20 percent. One generic is not necessarily bioequivalent to another generic. It is therefore highly questionable whether an original drug should be replaced by a no-name generic. Generic drugs should never be used if a better but non- generic medication is available.

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Frothingham R. "Me-Too" Products — Friend or Foe? NEJM 350(20):2100-2101,2004 The proliferation of "me-too" drugs leads to beneficial cost reductions, but it may also put patients at risk. Each me-too drug comes to the market with limited clinical experience as compared with compounds already in use. –Five me-too drugs in the statin and quinolone classes have been withdrawn or restricted because of serious adverse effects that were not recognized until months or years after their approval –temafloxacin, grepafloxacin, cerivastatin, sparfloxacin, and trovafloxacin. Therefore cost–safety issue has no simple answer.

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Health care habits of elderly  use over-the-counter medication regularly including “jamu” containing “steroid”  get medications from more than one pharmacy, or from friends  visit several doctors, each of whom may prescribe different medications  complain a lot of symptoms  prescribing cascade